Basic Information
| Provider Information | |||||||||
| NPI: | 1295082477 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LATHIEF | ||||||||
| FirstName: | SANAM | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 725 CONCORD AVE STE 6100 | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021381040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178648822 | ||||||||
| FaxNumber: | 6173541318 | ||||||||
| Practice Location | |||||||||
| Address1: | 725 CONCORD AVE STE 3300 | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021381055 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6178648822 | ||||||||
| FaxNumber: | 6173541318 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/07/2012 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD15691 | RI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 207RE0101X | 285707 | MA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
ID Information
| ID | Type | State | Issuer | Description | 110165445A | 05 | MA | MEDICAID |